Provider Demographics
NPI:1225243462
Name:SHAKAIB, MOHAMMED IRFAN II
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:IRFAN
Last Name:SHAKAIB
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W BRIAR PL APT 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4665
Mailing Address - Country:US
Mailing Address - Phone:847-845-6063
Mailing Address - Fax:
Practice Address - Street 1:SAINT JOSEPH HOSPITAL
Practice Address - Street 2:2900 N LAKESHORE DR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-665-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine